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COBRA Election Notice Forms

Advise employees of the availability of extended COBRA coverage and sign them up

Item Type SKU Qty Price
Packs of 25 EZ-409 $12.95
   
   

By order of the Employee Benefits Security Administration (EBSA), if you have 20 employees or more and you offer health benefits, you must provide an updated general COBRA notice to any employee who becomes eligible to participate in the company's health plan.

Use our COBRA Election Notice Form to advise employees of the availability of health coverage extension under COBRA.

Failure to comply with COBRA notice rules can result in fines of up to $110 per day. (29 USC 1132(c)); as well as retroactive COBRA coverage and attorney's fees (29 USC 1132(g)

Ongoing 30-day violations can result in fines up to $3,300.

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